Update on Measles Mortality Reduction in India

Report
Measles
update- India
Dr. Satish Kumar Gupta
Health Specialist
UNICEF- India
13th September 2011
June 2011
1
Presentation outline
• Global context
• Update on accelerated measles control
– MCV-2 in Routine services
– Catch-up campaigns
– Laboratory supported measles surveillance
• Linkages with RI, recent publications
• Conclusions
Principles of accelerated measles control
strategies in India
1. Improve and sustain routine immunization
coverage (MCV-1)
2. Provide a second opportunity for measles
immunization to all eligible children (MCV-2)
3. Sensitive, laboratory supported measles outbreak
surveillance for case/outbreak confirmation
4. Fully investigate all detected measles outbreaks
and ensure appropriate case management
Global Context: Worldwide measles
vaccination delivery strategies, mid-2010
India
MCV1 & MCV2, no SIAs (40 member states or 21%)
MCV1, MCV2 & one-time catch-up (36 member states or 19%)
MCV1, MCV2 & regular SIAs (57 member states or 28%)
MCV1 & regular SIAs (59 member states or 31%)
Presentation outline
• Global context
• Update on accelerated measles control
– MCV-2 in Routine services
– Catch-up campaigns
– Laboratory supported measles surveillance
• Linkages with RI, recent publications
• To conclude
2nd Dose of Measles vaccine:
State specific delivery strategies
SIA: MCV1 <80%
RI: MCV1 > 80%
MCV1: Coverage of Measles containing vaccine
per DLHS-3; CES-06 for Nagaland
2nd Dose of
Measles in RI
• 17 states (MCV1>80%)
introduced measles 2nd
dose in their routine
immunization program
• 45 districts, who
completed measles
campaign in phase -1
are in process of
introducing 2nd dose in
their RI program
MCV2 introduction through Supplementary
Immunization Activity (SIA) in Phases
Phase 1
 Initiated in November 2010;
 45 districts from 13 states
o 9 district from Chhattisgarh
o 5 districts from each of the 6
states (Bihar, Jharkhand,
Rajasthan, Madhya Pradesh,
Gujarat & Haryana)
o 1 district from each of the 6
North-East states
 Approximately 14 million target
children 9 months – 10 yrs
Coverage achieved: Administrative and
RCA monitoring
Reported Coverage
RCA Coverage
100
90
80
percentage (%)
70
60
50
40
30
20
10
11,963,663 of 13,845,686 vaccinated (86.4%)
18 of 45 districts with >= 90% coverage (40%)
Data as on 12 July 2011
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Reasons for un-vaccinated children:
RCA surveys results
Parents didn't know about the campaign
11
10
Parents didn't know about place or date
of the place or date of the campaign
Fear of injection
9
20
IEC/IPC
(43.7%)
Fear of AEFI
9
Parents didn't give importance
Child was traveling
10
16
Child was sick
Un-aware of
need
(43.9%)
There was no vaccine at the site
11
There was no vaccinator at the site
Site was too far
20
3
Very long queue
Other Reason
N=unvaccinated children; 30,200
Note: Figures are % of total responses provided
Operational Gap
(3.7%)
Selected session quality indicators
n=22,343
% session site with adequate vaccine & syringes
97.4%
% sites where diluents kept cool before reconstitution
98.4%
% sites where time of reconstitution written on vial
93.5%
% sites where reconstituted vials kept in the hole of 1 icepack
97.4%
% sites where sterile part of syringe remained untouched
95.4%
% sites where vaccinators following ‘no recapping’
89.4%
% sites where vaccinators know what to do in case of a serious AEFI
93.2%
% sites having functional hub cutter
87.6%
% sites where supervisor visited once in a day
75.4%
n=campaign vaccination sessions were monitored
Enhanced AEFI surveillance during
the Measles catch-up campaigns
 304 minor AEFIs and 40 serious AEFIs reported
 All serious AEFIs reported and correctly managed
 NO DEATHS – VACCINE OR PROGRAMME RELATED
Lesson learnt from 1st Phase:
Areas for improvement
• Coordination and planning:
– Better coordination of the three primary department of Health, Education
and ICDS
– Clear timelines of availability of logistics
• Communication and advocacy:
– IEC ,BCC and interpersonal communication
– IAP, IMA and private doctors sensitization
– Private school principals orientation
• Vaccination in urban areas
• Injection waste management
• Supervision at all levels
Measles SIA plan, India
Phase 1, 45 districts covered
Phase 2 A (144 districts)
Phase 2 B (81 districts)
Phase 3 (91 districts)
Total target- 135 million children
Districts- 361
Planned phases of measles catch-up
campaigns
Dates
No. districts
Target population
(9m-10yrs)
Phase 1
Phase 2A
Phase 2B
Phase 3
Q4 2010 –
Q2 2011
Q3 – Q4
2011
Q1 2012
Q4 2012
45
144
81
91
361
14.0
41.5
33.4
47.0
135.0
millions
Children
vaccinated
(millions)
12.0
Total
Expansion of measles outbreak
surveillance
• Reporting of clinical
measles cases linked
with AFP weekly
reporting in these
states
2006
2007
2009
2010
2011
• One state level lab
strengthened in each
state testing for
measles and rubella
IgM
Serologically confirmed measles outbreaks:
Age and vaccination status of measles cases*, 2011
Total cases = 9,221
4000
3800
3600
3400
3200
3000
2800
2600
2400
2200
2000
1800
1600
1400
1200
1000
800
600
400
200
0
 61 % no or unknown
vaccination status
 86 % < 10 yrs of age
< 1 year
1-4 years
Vaccinated
5-9 years
Not Vaccinated
10-14 years
>= 15 years
Unknown
* Serologically and epidemiologically confirmed cases
* data as on
15th
Jun, 2011
** Data from 8 states (Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh,
Rajasthan, Tamilnadu and West Bengal
Serologically confirmed# measles, rubella and
mixed outbreaks
(Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Rajasthan, Tamil Nadu and West Bengal)
2011*
2010
#
Widespread measles virus
transmission indicating gaps in RI
129 outbreaks
109
10
10
* data as on 15th Jun, 2011
219 outbreaks
Measles outbreaks confirmed
Rubella outbreaks confirmed
Mixed outbreaks confirmed
#
198
16
5
Outbreak confirmation for Measles: 2011 ≥ 2 cases IgM positive for measles and rubella
Presentation outline
• Global context
• Update on accelerated measles control
– MCV-2 in Routine services
– Catch-up campaigns
– Laboratory supported measles surveillance
• Linkages with RI, recent publications
• Summary and way forward
RI – Measles synergies
• Measles catch-up campaigns has helped, RI
– By augmenting AEFI surveillance (reporting & management)
– By improving injection safety practices on a large scale
– By enforcing waste management practices (as per national
guidelines)
– By optimizing cold-chain space & efficient vaccine stock
management practice at various levels (state/district/block)
– Encouraging fixed-day , fixed-site session based approach
• RI-Measles Synergy study is being done in Jharkhand
• Year 2012 declared Year of intensification of RI
– Operational plan under development
Recent
Publications
•
•
•
Introduction Strategy of a
second dose measles
containing vaccine in
India. Indian Pediatrics
May 2011
Measles vaccine vs MMR
reply Indian Pediatrics
Sept 2011
Global Immunization
Newsletter (GIN)
November 2010
Presentation outline
• Global context
• Update on accelerated measles control
– MCV-2 in Routine services
– Catch-up campaigns
– Laboratory supported measles surveillance
• Linkages with RI, recent publications
• Conclusion
To conclude…
India is fully committed to
control measles mortality
as per its MYP
Expansion of measles
surveillance to document
virus transmission
following the campaigns
Exploring how, Routine
immunization could be
further strengthened
using Measles campaigns
Thank you!
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